MEDICARE: UNION EYE CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	3516SC	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972677094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION EYE CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	4750 BEIDLER RD
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4604
Country	:	US
Telephone Number	:	216-986-9700
Fax Number	:	216-986-1996

Provider Business Practice Location Address
First Line	:	7593 MENTOR AVE
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5407
Country	:	US
Telephone Number	:	440-942-7714
Fax Number	:

Authorized Official
Title or Position	:	DIR. OF ADMINISTRATION & GROUP SALE
Name	:	PAUL PREISZIG
Credential	:	OPTICIAN
Telephone Number	:	216-986-9700

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/12/2007

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